Provider Demographics
NPI:1699545822
Name:BAHAM, JODY MILFORD (FNP-BC)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:MILFORD
Last Name:BAHAM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 GRAVEL WAY
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:GA
Mailing Address - Zip Code:31302-8120
Mailing Address - Country:US
Mailing Address - Phone:706-599-7174
Mailing Address - Fax:
Practice Address - Street 1:37 W FAIRMONT AVE STE 317
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3458
Practice Address - Country:US
Practice Address - Phone:912-925-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN287159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily